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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> Date 4p <br /> OFFICE USE ONLY <br /> To: San Joaquin County JOB# a 3o�j�.(G, REF# <br /> Department of Public Works APN <br /> CR# <br /> EXP. DATE 2. 1•to <br /> Pacific Gas and Electric Co. VALID I Zo•vg TO •( !O DRIVEWAYS: <br /> P.O. BOX 930 STREET <br /> AREA QUAD S <br /> Stockton, CA 95201 TYPE 3-,- ----- » <br /> FORMS Lc� <br /> NOTES <br /> '94 2- <br /> (Area Code-Telephone Number) <br /> Sketch(Detailed plans may be submitted) <br /> See abfi <br /> ttached sketch. Traffic Control Plan <br /> Shall be as per <br /> PM X70 7CIM7 current M.U.T.C.D. <br /> Notif. <br /> California supplement. <br /> The der i ned hereby applies or p r iss'op to excavate,construct and/or otherwise encroach n C <br /> the side of ounty HighwayRight-of-Way on <br /> of approximately. <br /> feet/sift <br /> by performing the following work(description of work); <br /> Work will commence on or about <br /> for approximately <br /> I,the undersigned,certify that I am the owner of the respective property, days. <br /> work described above in accordance with the rules and regulations of San Joaquin qualified <br /> my and reprsubjeesent ct o inspection ownerdand approval., <br /> doe <br /> Signature of Applicant-Title <br /> B-SV.WIQM0.5TERPSIENCROACNMEM PERM Date <br /> Return hermits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />